February 5, 2011

Once known as Hepatitis Non A Non B, Hepatitis C is being discussed a lot in the using community. Here, BP goes behind the ‘Hep C test’ where many of us stop, discovering why further tests are so important in getting to the bottom of your own Hep C diagnosis.

Research by M.M, B.L, EO

In the last issue, BP ‘introduced’ the liver, briefly discussing what it does and how it does it. This issue, we want to look more closely at a virus that has affected the livers of an estimated 250,000 – 600,000 people in the UK alone, 170 million people worldwide with some 3 million more joining the global ranks each year. BP wanted to find some straightforward answers to some essential questions on Hepatitis C and what you may want to consider if you have been diagnosed Hep C (HCV) positive. (BP will look into treatments for HCV next issue).

Hepatitis C is?…

The actual word “hepatitis’ means inflammation or swelling of the liver. This can be caused by chemicals, drugs, drinking too much alcohol or by different kinds of viruses. Hepatitis C is just one of a number of hepatitis viruses (including A, B,D, E, G) and they are all completely different from one another. It can be hard to get your bead around just how small viruses really are. HCV is estimated to be 80 nanometers in diameter (around 30 billion would fit on this dot {,} – another reason why handwashing before and after injecting is so important; be especially vigilant if someone injects you after they’ve just had a hit – they could have microscopic particles of blood on their fingers and then may place them on your injection site. HCV is known to be remain active outside the body for some time so wash your hands and tell others to wash theirs! The hepatitis C virus is in fact a group of viruses, similar enough to be called HCV virus, yet different enough to be classified into subgroups.

Genotypes

Several families of hepatitis C have been observed around The world and these are known as genotypes, because they differ in their genetic make up. They arc usually classified as HCV genotype 1 ,or 2, or 3, etc. Some genotypes respond better to treatment than others so it is important to identify your genotype when considering treatment for Hep C..

Subtypes

Within each genotype, there are subtypes. These are classified as HCV subtype la, or Ib, Ic, etc and within a subtype, incredibly minute differences will exist among individual viruses, called quasispecies – several million quasispecies would exist within a subtype.

How Might HCV Affect Me?

Hepatitis C affects people differently; some are not affected by it while others can be affected seriously. If you contract hepatitis C, your body will produce antibodies to try and destroy it A HCV lest (referred to as an anti-HCV test) will look for the presence of these antibodies and if found, your result will be HCV antibody positive. However, too many of us stop here, terrified that we now have Hep C. But an antibody positive test is only showing ‘exposure’ to the virus – it does not tell you whether you have ‘active’ virus in the blood. Research shows that of 100 people infected wilh HCV, 25 will clear the virus from their bodies completely with 2-6 months of infection but will continue to carry the antibodies for some time. (These are usually people who were infected when they were younger).

This is why if you have received an HCV antibody positive test, further tests are necessary to determine whether there is still an infection present (see PCR tests opposite) and of course, get yourself some follow up tests for your Hep C, certain discoveries might make all the difference. to help identify the extent of any liver complications or disease – and your suitability for the newer HCV treatments. (BP investigates this next issue). Research estimates the other 75 who do not clear the virus will have ongoing (chronic) infection and some arc at risk of developing complications or liver disease. Of these people, approximately 20 may never experience any noticeable symptoms and although they can still transmit HCV, they won’t develop illness or liver disease.

Symptoms Related to HCV

After 10-15 years, the majority of people with hepatitis C will have developed different levels of liver damage that will result in hepatitis C

Some aspects of the disease are still not fully understood and it can be difficult to predict what will happen for any one person. Symptoms can stay at a certain level and dont always get worse. They can come and go with no real pattern. Over a 40 year period of infection, it is believed that: less than 4% of people with chronic hepatitis C would develop liver failure or liver cancer.. Over a 40 year period, 20% of people with chronic (ongoing) HCV infection will develop cirrhosis of the liver.

I’m Hep C Positive – Now What?

After you receive your antibody positive diagnosis, you can be offered (or request) a referral lo see a specialist. They should then offer you a series of tests such as:

Many doctors advise people with hepatitis C to have the hepatitis A and B vaccinations. Although the viruses are unrelated, such vaccinations will help prevent possible additional liver complications caused by having more than one viral infection at the same time.

What is a PCR Test?

PCR stands for polymerase chain reaction. PCR tests detect or measure the actual hepatitis C virus in a sample of blood There are three types of PCR test – viral detection, viral load and viral genotype. These tests assist people to:

The PCR viral detection test is mainly used as a confirmatory test when an antibody test result is inconclusive. It is important as you may have received an antibody positive test only to have cleared the virus at a later date. The PCR viral detection test can also be used by HCV positive pregnant women to determine the chance of them transmitting HCV to their child.

This PCR lest measures the amount of HCV circulating in someone’s blood. Measuring the level of virus in someone’s blood before treatment can help determine whether a 6 or 12 month treatment regime is preferable.

PCR viral genotype test PCR genotype tests can determine what HCV genotype and subtype a person has. This is useful information as it has been shown that people who have particular genotypes generally respond better to drug treatment Important note: PCR tests look for virus in the blood. Levels of virus in people’s blood can fluctuate and, at times, the level of virus in someone’s blood might be too low for the PCR test to detect it. Therefore, a negative PCR test result may not always mean that a hepatitis C antibody positive person doesn’t have hepatitis C just that the test couldn’t detect the virus in (hat particular sample of blood. For this reason, people should rely on a series of at least two PCR tests done over a 4-6 month period, rather than a single PCR test.

How Can I Tell What’s Happening to my Liver?

Liver function tests (LFTs) (see BP Issue 1) are used to measure the general condition of the liver. Liver function tests measure levels of particular enzymes or proteins in a person’s blood. If liver cells are damaged, increased levels of these substances “leak out” into the bloodstream and show up as raised or abnormal results in liver function tests. The tests provide only a rough indication of possible liver damage. Liver function tests may be suggested monthly or up to once per year depending on a person’s condition. Liver function tests do not provide conclusive evidence of what is happening in the liven some people may feel quite ill yet have little liver damage. For other people, damage may be occurring even when liver enzyme levels arc normal. It is important to remember that raised liver function test results may be caused by medical conditions other than HCV In cases where ALT readings are consistently high for a long time, where they fluctuate greatly or when readings don’t seem to match with how a person feels, a specialist may suggest a liver biopsy be done. Some doctors recommend a routine liver biopsy after 15 years of infection and then every five years thereafter.

What is a Liver Biopsy?

A liver biopsy provides the most accurate report on the condition of someone’s liver. Using a special instrument, a specialist doctor takes a small sample which is then examined under a microscope. Ultrasound and other x-rays can indicate certain liver-related abnormalities but have difficulty distinguishing cirrhosis (scarring of the liver) from other conditions such as fat accumulation in the liver. This is particularly true in early cirrhosis. The diagnosis of cirrhosis can only really be made by liver biopsy. However, the presence or absence of cirrhosis is only part of the information available from liver biopsy. Apart from showing the amount of scar tissue (an indication of what has happened to the liver in the past), liver biopsies also show how active the hepatitis C is now and if there are other factors interacting with the hepatitis C to damage the liver such as excess alcohol or iron accumulation in the liver. (BP will cover biopsy’s in more detail in an upcoming issue).

How Accurate Are Liver Biopsy’s?

A liver biopsy sample is just a tiny piece of the liver and people have said it can be hit and miss depending on the bit of the liver taken, but a properly taken sample is generally representative of changes throughout the liver. Hepatitis C affects the whole liver and although there may be some variation within the liver,this would be a minor, rather than major, variation.A doctor will usually explore two major issues in looking at the liver biopsy: Firstly, are the features consistent with HCV as the cause of the liver test abnormalities? ie. Are there other Ever illnesses present? Secondly, if the biopsy is consistent with HCV, then how badly is the liver damaged? This can be estimated by studying three main parameters:

+ The amount of portal inflammation – this is the inflammation around liver cells, bile ducts and veins in parts of the liver

+ The amount of tabular inflammation – the amount of inflammation in separate lobules (the left, right and smaller subdivisions of the liver)

+ The amount of fibrosis – this is an early stage in the development of liver cell scarring (cirrhosis).

NOTE: Liver biopsies are not used as much in 2011 as they were around 2000 as a more modern, less invasive type of liver ultrasound is preferred.

Is Treatment Successful?

It is important that you develop a partnership with the healthcare professional who will be responsible for your cart. It may be your GP, specialist or alternative healthcare practitioner or better still, a combination of the three. There are some real strides being made in terms of treatment for HCV and treatment outcomes, though variable depending on each individual (lifestyle and viral factors and certain lifestyle changes made can also impact positively on your quality of life). The best course of treatment currently available involves a combination of two drugs; pegylated interferon and ribavirin. Treatment response rates using pegylated alpha interferon plus ribavirin are in the order of 55% (with genotype 1 results of 45%, and genotype 2 and 3 results of about 80%). For the few people unable to tolerate combination therapy, alpha interferon on its own is sometimes beneficial. However, not everyone is considered suitable for treatment Some people need only regular assessment to detect if damage to their liver is occurring or progressing. NB As of 2011, new treatment therapies for HCV are looking much more promising. It is well worth doing a bit of research into what is available through some of the excellent Hep C resources available these days. Treatment can be exhausting and hard work for your body so its important to be prepared and have support.

Discriminated Against for Being HCV+?

If you feel you have been discriminated against because of your status or treated unfairly, there is a group who may be able to advise you on your rights relating to almost any matter that you feel is connected with your hepatitis C.

NOTE: The Disability Rights Commission (DRC) closed on 28 September 2007. Its responsibility for helping secure civil rights for disabled people has transferred to the new Equality and Human Rights Commission which opened for business in 1 October 2007.

Or Call the HEP C Trust (UK) Helpline: 0845 223 4424 10.30 to 4.30 Monday to Fri – people affected by Hep C man the helplines and give good quality information and advice

Thanks to British Liver Trust & The Australian HEP C Council of NSW http://www.hepatitis.org.au/ for their excellent resources and information, some of which is represented here.

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